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For Douglas Davies, whose wisdom and insight live on

For Tobi Hanna-Davies, who honored Doug

by willing this edition into being

For Cynthia Koehler Troy

and her loving, if irrational, patience with me
—M. F. T.
About the Authors

Douglas Davies, MSW, PhD, until his death in 2015, was Lecturer at the
School of Social Work, University of Michigan. An infant mental health spe­
cialist, he published numerous clinical articles on intervention with toddlers
and parents, traumatized children, and child cancer survivors. Dr. Davies’s
most recent practice was devoted to reflective supervision of mental health
clinicians and child care consultants, consultation to agencies, and training of
clinicians on topics in child development and child therapy. He was inducted
into the National Academies of Practice as a distinguished social work practi­
tioner, and received the Selma Fraiberg Award from the Michigan Association
for Infant Mental Health.

Michael F. Troy, PhD, LP, is a clinical psychologist at Children’s Minnesota,

where he is Medical Director of Behavioral Health Services and Associate
Medical Director of Children’s Neuroscience Institute. Dr. Troy’s clinical and
academic interests include diagnostic classification issues in developmental
psychopathology, models of therapeutic assessment, psychological assessment
of adolescents at risk for major psychopathology, and teaching child clinical
psychology as part of hospital and community medical education programs.

 vii
Series Editor’s Note

The task of reviewing and writing about this book comes with mixed feelings
of sadness and pride because of my past professional relationship with Doug­
las Davies since the publication of the first edition of this book in 1999. It
was a pleasure to work with Doug on the first three editions and to hear from
professors, students, and practitioners in the United States and abroad how
much they valued the wisdom and guidance they found in these books. Doug
had been deeply involved in writing this fourth edition prior to his untimely
death from congestive heart failure in June 2015, and I feel confident that he
would want his writings to continue to provide insights and guidance for prac­
titioners and students for as long as possible. Doug was committed to teach­
ing and consulting with practitioners and students about how to help young
children and their families, and his books have been an invaluable resource
for this purpose. I am happy that Michael Troy has added his own expertise
for this worthy mission.
As I emphasized in the Series Editor’s Note in the third edition, in 2011,
this book on child development provides an essential foundation for all prac­
titioners who work with children. This statement continues to apply to this
fourth edition, which, like its predecessors, emphasizes the critical impor­
tance of parent–child relationships and the social environment, as well as the
child’s brain development during his or her early formative years. In addition
to its value as a solid reference work, the book is a pleasure to read! Numer­
ous case examples bring the theoretical content to life through illustrations of
the delicate balance between risk and resilience factors as these interact with
the child’s biological reality. In addition, the child’s caretaker has a positive or

 ix
x  Series Editor’s Note

negative influence through interactions that may include either protective or

careless, ambivalent, or hostile relationships, often rooted in the caretaker’s
own history. As these details become clear in the text, involvement of the
caretaker (usually the parent) in the child’s transactional and bidirectional
treatment is crucial in influencing the child’s future development.
The impact of violence in families and communities creates a disrup-
tive and stressful environment for everyone. Traumatic events affect a child’s
developing brain and also may influence the nature of attachment relation-
ships, making caretakers less able to offer the comfort and safety that would
soothe a fearful young child. Practitioners must be prepared to advocate for
timely mental health intervention to ensure that children do not develop mal-
adaptive defensive responses after traumatic exposure.
This book, like the previous editions, serves as a basic resource and refer-
ence for students and practitioners who work with young children and their
families. It demonstrates the importance for clinicians to have a solid grasp
of knowledge about early development in order to understand and treat a
child’s problematic behavior. Children’s early experiences of stress can have
lasting effects that can be mitigated when practitioners understand the impact
of these experiences and involve caretakers in alleviating their negative effects.
I am very happy to have this updated fourth edition as part of The Guil-
ford Press series Clinical Practice with Children, Adolescents, and Families.
It will serve as an essential reference for practitioners in schools, family agen-
cies, child welfare programs, hospitals, and community programs. As with
previous editions, it will continue to be assigned as a text in courses that deal
with children and human behavior and development. It has been well received
in the earlier editions, and my hope is that the culmination of clinical wisdom
reflected in these pages will continue to enhance the learning and subsequent
treatment by practitioners for the benefit of countless children in the United
States and abroad. Doug Davies can be proud of the significant and ongoing
impact of his work!

Nancy Boyd Webb , DSW

Author’s Note

Dr. Douglas Davies’s celebrated career as a clinician, teacher, and author

spanned decades, influencing countless clinicians and students. His book
Child Development: A Practitioner’s Guide has served as a valuable resource
within the field of applied child development for years, across three editions.
At the time of Doug’s untimely death in 2015, he had begun work on
the fourth edition of his book. Recognizing that the field continued to need
the guidance Doug’s book offered, his wife, Tobi Hanna-Davies, generously
decided to honor Doug by approving a coauthor to complete the revision Doug
had begun. Consequently, when I was offered the singular opportunity to fill
this role, I recognized both the honor and challenge it represented. In agreeing
to this project, I committed to maintaining fidelity to Doug’s core theme of
the centrality of understanding child development in the service of compas­
sionate and effective clinical work. I believed my own training and ongoing
clinical interests were consistent with, and complemented, those of Doug and
the book he created. In particular, Doug and I both hold attachment theory
and its relevance across the developmental continuum, as well as the neurobio­
logical underpinnings of risk and resilience, as core constructs foundational
to child clinical work. And although I am a clinical psychologist and Doug
was a social worker, I’ve had the good fortune to spend a substantive part of
my career working in a children’s hospital where respect and curiosity across
professional identities is the norm. Among the many reasons that I hold Doug
in such high esteem is the clarity of his commitment to helping children and
families, a commitment that has inspired those working with children, regard­
less of their specific credentials or specific service settings in which they work.

 xi
xii  Author’s Note

In working on this fourth edition, my goal has been to update the devel­
opmental science supporting Doug’s themes and lessons without changing the
compelling way in which he describes how to do meaningful clinical work.
And while I have sought to bring my own perspective and knowledge to this
project in ways that add value to the book, I have also sought to maintain
Doug’s voice as primary, as it should be. It is for this reason that I have, wher­
ever possible, included in this edition the case examples developed by Doug.
While certain updates and changes are included, most represent Doug’s own
work as a master clinician. Consequently, with the exception of the final chap­
ter, these cases are presented with Doug speaking in the first person. I felt that
it was a fitting way for Doug to continue speaking directly to us all.

M ichael F. Troy
Preface

This book describes child development and how it can be applied to prac­
tice with children. Beginning practitioners often feel intrigued and perplexed
by the behavior of children and wonder what is “normal.” Developmental
knowledge provides a framework for understanding children in relation to
the tasks and issues relevant to their age. These, in turn, are determined by
physical, social, emotional, and neurodevelopmental norms that transform in
meaningful ways from birth through adolescence. Only with a sound ground­
ing in this knowledge can we determine whether a child’s emotions, thoughts,
or behaviors fall within normal expectations. Any given piece of behavior
can be normal, mildly abnormal, or reflective of serious problems, depending
on its developmental timing and the context within which it occurs. It is not
unusual, for example, for a 4-year-old occasionally to be frightened by mon­
sters and ghosts, at least at bedtime, while the same beliefs in a 10-year-old
may indicate generalized or trauma-based anxiety, causing a lapse in reality
testing and sense of safety. By demonstrating the value of a developmental
framework, we intend to make this book as useful as possible to practitioners
working with children.
Knowledge of the abilities and developmental tasks that are typical of
children of a given age can inform our clinical work and casework in power­
ful ways. Knowing what developmental tasks the child is currently working
through helps us empathize with the child directly, allowing us to enter the
child’s world, as opposed to merely seeing him or her as a set of symptoms.
Knowing where a child is functioning developmentally, especially as this
relates to presenting symptoms, helps us define what skills and capacities to

 xiii
xiv  Preface

target in our treatment plans. Knowing what skills and capacities will soon
be appearing as a result of development, in turn, helps us plan interventions
that utilize and support these emerging abilities. Knowing how children at a
particular developmental level represent themselves—through behavior, play,
and words—informs how we communicate with them and helps us plan treat­
ment activities, using appropriate materials. Knowing what a child cannot
do because he or she has not reached a particular developmental level creates
realistic expectations about the goals of treatment and improves our ability
to communicate with the child’s caregivers. This compelling, informed devel­
opmental perspective allows us to do clinical work that goes beyond the goal
of decreasing symptoms by also recognizing that the promotion of positive
development also promotes healing, growth, and resilience.
A developmental perspective also provides us with a lens to review and
understand a child’s history. To truly appreciate how earlier experiences influ­
ence children’s current functioning, we need to understand the developmental
pathway leading to their current strengths and limitations for handling stress
and trauma.

PLAN OF THE BOOK

The fourth edition of this book retains the basic structure of the previous
edition. Part I, “Contexts of Development: A Transactional Approach,” intro­
duces the idea that the child’s development is the outcome of the interplay of
normative developmental maturation and the context within which it occurs.
We begin with a brief discussion of this developmental process. This is fol­
lowed by chapters describing attachment with the primary caregiver, as well
as how attachment history affects other relationships over time. We then
describe the role of neurodevelopment and the ways in which risk and pro­
tective factors influence the course of development. The application of these
concepts is illustrated with case examples.
Part II, “The Course of Child Development,” represents the core of the
book, looking at childhood through the lens of discrete expected stages.
Chapters 5, 7, and 8, 10 and 11, and 13 and 14 cover infancy, toddlerhood,
the preschool period, and middle childhood, respectively. They summarize
the salient tasks and issues of each of these developmental stages, both within
core domains and as an integrated whole. In addition to presenting informa­
tion from the research literature, we also provide brief observations of chil­
dren in their “natural” settings—home, child care center, school, playground,
neighborhood—as well as in practice settings.
The chapters that review each developmental stage are followed by a
practice chapter (Chapters 6, 9, 12, and 15) that presents ways of applying
information about development to clinical practice. These chapters illustrate
how each period in development has special issues and characteristics that
shape our practice, so that we can respond helpfully to our child clients and
 Preface  xv

their parents. The developmental norms of each period provide opportunities

and limitations that must guide our work. For example, while we cannot rely
on simply asking 4-year-olds to tell us about their concerns, their imaginative
play may well lend us insight into clinically meaningful worries and anxieties,
as well as a vehicle for addressing these through the use of therapeutic play.
Since the best way to make developmental concepts real is to observe children
at different developmental levels, we suggest observational exercises at the end
of each practice chapter. Our aim throughout is to demonstrate how to think
developmentally in practice with children and their parents, and how to use
our understanding of development to inform our practice.
In our final chapter, we summarize the underlying themes of this book,
highlighting their application to child clinical work. We also discuss the
importance of the emerging science of early child development and note the
importance of our growing understanding of adolescence as a distinct devel­
opmental period.
Acknowledgments

In acknowledging the contributions of others to his work, Doug made certain

to thank, as I’m certain he would wish to do again, the children and families
that were his clients and from whom he learned much about child develop­
ment and clinical practice. Similarly, Doug has been generous in crediting and
diligent in thanking his students and colleagues at the University of Michi­
gan School of Social Work. Doug supervised clinicians from and consulted
to a wide range of organizations, including the State of Michigan Child Care
Enhancement Program, the Michigan Association for Infant Mental Health,
the Seneca Center’s Building Blocks Therapeutic Preschool in Oakland Cali­
fornia, and the reflective supervision groups he led in Traverse City and
Southgate, Michigan; Richmond, Virginia; Honolulu, Hawaii; and Anchor­
age, Alaska. All these organizations, and the individuals who worked with
Doug, should never doubt his gratitude to them. It is beyond my ability to fully
understand or appropriately express what I can only imagine Doug would say
about his family given the opportunity to thank them in this context. I believe
the best I can do is to include Doug’s own words from the previous edition
of this book: “My family—Tobi, Aaron, Elizabeth, Hannah, Hayden, Justin,
Laurel, Sage, and Gillian—continued to provide me with love, support, inter­
est, and at times (especially from grandchildren), encouragement to hurry up
and finish. I love them and thank them.”
I wish to thank, first and foremost, Tobi Hanna-Davies for allowing me
the high honor and privilege of building on the foundation of Doug’s work.
I am deeply grateful for the opportunity to ensure that the knowledge and
passion of Doug’s distinguished career continues to be shared with the com­
munity of child clinicians.

 xvii
xviii  Acknowledgments

There are many to thank at The Guilford Press, without whom this book
would not be possible. I thank you all. For many reasons, I am most grateful
to Jim Nageotte, Senior Editor, who first approached me about this project.
Jim encouraged me throughout the long arc until its completion and, at least
as far as I could tell, refused to be discouraged or distracted by my periodic
setbacks and detours. Thank you for the leap of faith and steady guidance.
Books like this are not completed without people like Jane Keislar, Senior
Assistant Editor, whose diligent attention to detail and thoughtful editing
were indispensable. Thank you, Jane. I also extend my deep appreciation to
Paul Gordon, Art Director; Katherine Lieber, Senior Copywriter; Jacquelyn
Coggin, Copy Editor; and Laura Specht Patchkofsky, Senior Production Edi­
tor. Guilford has a wonderful team, and we are grateful for the opportunity
to join with them to create this book.
I also wish to acknowledge the many researchers and clinicians whose
work has informed and inspired what this book has to offer. Many of these
individuals are cited directly; many others helped create the developmental
and clinical world we live in and taught us to be the clinicians we’ve become.
I am grateful to Children’s Hospital of Minnesota for being my clinical home
throughout my career, to my colleagues there and the families I’ve worked
with—I’ve learned from you all. Additionally, at the University of Minnesota,
Dr. Alan Sroufe taught me that attachment is the heart of development; at
Hennepin County Medical Center, Dr. Ada Hegion taught me how to be a
clinician; and through my ongoing involvement with the Pediatric Innovation
Initiative and the Harvard Center for the Developing Child, Dr. Jack Shonkoff
continues to teach me what it really means to translate research into practice.
I offer special thanks to Dr. Robin Hornik Parritz—she clearly lives in these
pages as well.
Finally, I thank my family—Cynthia, Brendan, Kevin, and Mimi—for
support, encouragement, and perspective. The gift of being husband, father,
and father-in-law in our wonderful family makes everything worthwhile. I am
grateful beyond words.
The play therapy case in Chapter 12 is substantially based on Davies
(1992) (copyright 1992 by Plenum Publishing Corporation; adapted with per­
mission from Springer Science and Business Media).
Contents

PART I  Contexts of Development:

A Transactional Approach
 Introduction to Part I:
3
Perspectives on Development
The Maturational Perspective 3
The Transactional Model of Development 4
Developmental Pathways and Intervention 5

CHAPTER 1  Attachment as Context for Development 9

How Attachment Develops 10
Functions of Attachment 10
Patterns of Attachment 13
Attachment Classifications 14
Attachment, Class, and Culture 22
The Universality of Attachment 23
Attachment and Future Development 24
Parental Models of Attachment 27
Attachment Theory and Family Systems Theory 31
The Attachment Perspective in the Assessment
of Young Children 32
Kelly and Her Mother: A Case Example 33
Conclusion 41

 xix
xx  Contents

CHAPTER 2  Brain Development 42

Sequence of Brain Development 43
Early Brain Growth:
Synaptogenesis and Myelination 44
Synaptic Overproduction and Pruning 45
Plasticity and Experience 46
Bonding, Attachment, and Brain Development 47
Mirror Neurons and the Social Brain 48
Can Parents Build Better Brains? 50
Risk and Protective Factors Influencing
Brain Development 51
Stress, Trauma, and Brain Development 53
Early Trauma and Brain Development 56
Studies of Institutionally Deprived
Young Children 60
Conclusion 64

CHAPTER 3  Risk and Protective Factors: 65

The Child, Family, and Community Contexts
Research on Risk and Resilience 65
Risk Factors 67
Protective Factors and Processes 104
Conclusion 107
APPENDIX 3.1. Summary of Risk
and Protective Factors 109

CHAPTER 4  Analysis of Risk and Protective Factors: 112

Practice Applications
How to Use Risk Factor Analysis 112
Prediction of Risk: Assessing Current Risk
and Protective Factors 113
Retrospective Analysis of Risk
and Protective Factors 123
Conclusion 130

PART II  The Course of Child Development

 Introduction to Part II:
133
A Developmental Lens on Childhood
Barriers to Understanding the Child’s Perspective 133
Dynamics of Developmental Change 135
Interactions between Maturation
and Environment 135
 Contents  xxi

Thinking Developmentally in Assessment

and Intervention 136
Organization of Developmental Chapters 136

CHAPTER 5  Infant Development 139

The Interaction between Maturation
and Caregiving 139
Brain Development: The Importance
of Early Experience 140
Metaphors of Infant–Parent Transactions 140
Caregivers’ Adaptations
to Developmental Change 142
The Neonatal Period: Birth–4 Weeks 142
Ages 1–3 Months 145
Ages 3–6 Months 150
A Normal Infant and a Competent Parent:
A Case Example 155
Ages 6–12 Months 158
Conclusion 169
APPENDIX 5.1. Summary of Infant Development,
Birth–12 Months of Age 169

CHAPTER 6  Practice with Infants 172

Assessment Issues 174
Assessment and Brief Intervention with an Infant
and Her Family: A Case Example 178
Conclusion 193

CHAPTER 7  Toddler Development: Core Domains 195

Physical Development 196
Attachment and Secure Base Behavior 196
Cognitive Development 202
Language and Communication 203
Symbolic Communication and Play 210

CHAPTER 8  Toddler Development: 214

Integrated Domains
Regulation of Emotion and Behavior 214
Moral Development 219
The Developing Self 225
Conclusion 232
APPENDIX 8.1. Summary of Toddler Development, 1–3
Years of Age 232
xxii  Contents

CHAPTER 9  Practice with Toddlers 236

Assessment 236
Assessment of Toddler Development:
A Case Example 241
Intervention: Parent–Child Therapy 255
Parent–Child Therapy with an Abused Toddler:
A Case Example 259
Conclusion 261

CHAPTER 10  Preschool Development: Core Domains 263

Physical Development 264
Attachment 266
Social Development 268
Language Development 275
Symbolic Communication and Play 280
Cognitive Development 282

CHAPTER 11  Preschool Development: 292

Integrated Domains
Regulation of Emotion and Behavior 292
Moral Development 301
The Developing Self 307
Conclusion 314
APPENDIX 11.1. Summary of Preschool Development,
3–6 Years of Age 314

CHAPTER 12  Practice with Preschoolers 318

Assessment 318
Child Care Consultation with a Preschool Child:
A Case Example 319
Intervention with Preschoolers 324
Using Play in the Treatment of Preschoolers 327
Medical Treatment
as a Developmental Interference 328
Play Therapy with a Preschool Child:
A Case Example 330
Conclusion 341

CHAPTER 13  Middle Childhood Development: 342

Core Domains
Physical Development 343
The Transition from Preschool
to Middle Childhood 344
Attachment 349
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